Our goal is to continue and extend our research program on the medical expenditures, medical care, and health of the elderly. In the proposed research, we plan to expand our core longitudinal Medicare databases (and linked supplemental datasets) to develop an integrated, long-term database on Medicare and Medicaid utilization for millions of elderly Americans, as well as integrated data on out-of-pocket payments and private insurance for smaller longitudinal samples. We will use this integrated database to describe the intertemporal distribution of the major components of medical expenditures for the elderly, the determinants of these expenditures, and the sources of changes in these expenditures over time, with particular emphasis on Medicare and Medicaid. We will describe and model the association of these expenditures with the treatment, disease status, and mortality. We will also analyze the determinants of transitions into Medicaid, and of transitions in and out of Medicare managed care- plans. These empirical studies will provide a foundation for comprehensive forecasts of Medicare and Medicaid expenditures, and the likely consequences of a broad range of reforms in Medicare, Medicaid, and private insurance. The integrated databases and research methods developed in this subproject will continue to provide a foundation for a broad range of studies on the economics of health for the elderly.